Evaluating Causation for the Opposite Upper Limb

2012 ◽  
Vol 17 (4) ◽  
pp. 1-10
Author(s):  
J. Mark Melhorn ◽  
James B. Talmage ◽  
Charles N. Brooks ◽  
Christopher R. Brigham
Keyword(s):  
Upper Limb ◽  
Clinical Evidence ◽  
Scientific Evidence ◽  
Epidemiological Studies ◽  
General Information ◽  
Work Related ◽  
Complex Process ◽  
Key Phrases ◽  
Injury Causation ◽  
Contralateral Shoulder

Abstract Workers’ compensation and personal injury claims often become embroiled in debates about the cause of the clinical presentation. When the primary claim involves an extremity, affected individuals sometimes report subsequent symptoms in the contralateral, previously “normal” limb and often attribute its onset to overuse while favoring the initially involved extremity; such an overuse hypothesis seems plausible, and perhaps intuitively obvious, to some. The concept that favoring one upper limb can result in injury to or illness in the other is not based on scientific evidence and instead is an unsupportable myth. Determining relationships between risk factors or exposures and medical conditions is a complex process that is outlined in the Guides to the Evaluation of Disease and Injury Causation (Causation). A search on PubMed and MEDLARS using the key phrases “opposite uninjured arm” and “uninjured arm” returned only six relevant articles, and the authors report that claims of serious or persisting painful syndromes in the arm or hand opposite the injured one are seldom adequately supported by clinical evidence. Similarly, the literature does not support “favoring” as a reasonable cause for development of symptoms in the contralateral shoulder or elbow. Epidemiological studies can provide general information regarding risk; this information must be filtered by specific steps to assess causal association for a disorder and determine if the injury is work related. Findings then can be applied to the specific individual.

Compensability of Common Upper Extremity Conditions When Work Activities Are Repetitive

2016 ◽  
Vol 21 (6) ◽  
pp. 3-4
Author(s):  
J. Mark Melhorn ◽  
LuAnn Haley ◽  
Charles N. Brooks
Keyword(s):  
Occupational Safety ◽  
Occupational Injury ◽  
Scientific Evidence ◽  
Individual Case ◽  
Cumulative Trauma ◽  
Work Related ◽  
Safety And Health ◽  
Repetitive Injury ◽  
The Individual ◽  
Injury Causation

Abstract Repetitive illness sometimes is wrongly called repetitive injury or cumulative trauma, but the latter are misnomers because the employee cannot identify a specific injury as a cause of the symptoms. In workers’ compensation, such gradual illness claims may be compensable if the condition arises during the course of employment, which requires that it be caused by occupational duties, exposures, or equipment used on the employer's premises. Expert impairment evaluators face three requirements: they must know the best scientific evidence currently available regarding causation of the condition(s) in question, ie, generic causation; the facts of the individual case, ie, specific causation; and the legal threshold in the applicable jurisdiction for acceptance of a condition as work related. The AMA Guides to the Evaluation of Disease and Injury Causation, Second Edition, is an excellent resource and provides the physician a blueprint for the assessment of causation in occupational injury and illness claims. The book adopts the methodology developed by the National Institute for Occupational Safety and Health and the American College of Occupational and Environmental Medicine. When asked to render opinions regarding causation, a physician is wise to consider this methodology in determining the work relatedness of the condition. Medical opinions based on an accepted methodology and the best scientific evidence will result in better patient outcomes.

Shoulder Pain at Work: Causation Analysis

2017 ◽  
Vol 22 (1) ◽  
pp. 11-16
Author(s):  
Joel Weddington ◽  
Charles N. Brooks ◽  
Mark Melhorn ◽  
Christopher R. Brigham
Keyword(s):  
Epidemiological Data ◽  
Case Law ◽  
Individual Case ◽  
Shoulder Injury ◽  
Work Related ◽  
Clear Cut ◽  
The Individual ◽  
Causation Analysis ◽  
Injury Causation ◽  
Relevant Factors

Abstract In most cases of shoulder injury at work, causation analysis is not clear-cut and requires detailed, thoughtful, and time-consuming causation analysis; traditionally, physicians have approached this in a cursory manner, often presenting their findings as an opinion. An established method of causation analysis using six steps is outlined in the American College of Occupational and Environmental Medicine Guidelines and in the AMA Guides to the Evaluation of Disease and Injury Causation, Second Edition, as follows: 1) collect evidence of disease; 2) collect epidemiological data; 3) collect evidence of exposure; 4) collect other relevant factors; 5) evaluate the validity of the evidence; and 6) write a report with evaluation and conclusions. Evaluators also should recognize that thresholds for causation vary by state and are based on specific statutes or case law. Three cases illustrate evidence-based causation analysis using the six steps and illustrate how examiners can form well-founded opinions about whether a given condition is work related, nonoccupational, or some combination of these. An evaluator's causal conclusions should be rational, should be consistent with the facts of the individual case and medical literature, and should cite pertinent references. The opinion should be stated “to a reasonable degree of medical probability,” on a “more-probable-than-not” basis, or using a suitable phrase that meets the legal threshold in the applicable jurisdiction.

scholarly journals Diabetes Mellitus, Cognitive Impairment, and Traditional Chinese Medicine

2015 ◽  
Vol 2015 ◽  
pp. 1-14 ◽  
Author(s):  
S. W. Seto ◽  
G. Y. Yang ◽  
H. Kiat ◽  
A. Bensoussan ◽  
Y. W. Kwan ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Chinese Medicine ◽  
Side Effects ◽  
Traditional Chinese Medicine ◽  
Cognitive Dysfunction ◽  
Scientific Evidence ◽  
Cerebrovascular Disorders ◽  
Blood Glucose Control ◽  
Epidemiological Studies ◽  
Therapeutic Benefits

Diabetes mellitus (DM) is a metabolic disorder affecting a large number of people worldwide. Numerous studies have demonstrated that DM can cause damage to multiple systems, leading to complications such as heart disease, cancer, and cerebrovascular disorders. Numerous epidemiological studies have shown that DM is closely associated with dementia and cognition dysfunction, with recent research focusing on the role of DM-mediated cerebrovascular damage in dementia. Despite the therapeutic benefits of antidiabetic agents for the treatment of DM-mediated cognitive dysfunction, most of these pharmaceutical agents are associated with various undesirable side-effects and their long-term benefits are therefore in doubt. Early evidence exists to support the use of traditional Chinese medicine (TCM) interventions, which tend to have minimal toxicity and side-effects. More importantly, these TCM interventions appear to offer significant effects in reducing DM-related complications beyond blood glucose control. However, more research is needed to further validate these claims and to explore their relevant mechanisms of action. The aims of this paper are (1) to provide an updated overview on the association between DM and cognitive dysfunction and (2) to review the scientific evidence underpinning the use of TCM interventions for the treatment and prevention of DM-induced cognitive dysfunction and dementia.

scholarly journals A Comparison of Work-Exacerbated Asthma Cases from Clinical and Epidemiological Settings

2013 ◽  
Vol 20 (3) ◽  
pp. 159-164 ◽  
Author(s):  
Paul K Henneberger ◽  
Xiaoming Liang ◽  
Catherine Lemière
Keyword(s):  
Health Maintenance Organization ◽  
The United States ◽  
Epidemiological Studies ◽  
Case Definitions ◽  
Health Maintenance ◽  
Work Related ◽  
Screening And Surveillance ◽  
Asthma Patients ◽  
Surveillance Programs ◽  
Doctor's Office

BACKGROUND: Clinical and epidemiological studies commonly use different case definitions in different settings when investigating work-exacerbated asthma (WEA). These differences are likely to impact characteristics of the resulting WEA cases.OBJECTIVES: To investigate this issue by comparing two groups of WEA cases, one identified using an intensive clinical evaluation and another that fulfilled epidemiological criteria.METHODS: A total of 53 clinical WEA cases had been referred for suspected work-related asthma to two tertiary clinics in Canada, where patients completed tests that confirmed asthma and ruled out asthma caused by work. Forty-seven epidemiological WEA cases were employed asthma patients treated at a health maintenance organization in the United States who completed a questionnaire and spirometry, and fulfilled criteria for WEA based on self-reported, work-related worsening of asthma and relevant workplace exposures as judged by an expert panel.RESULTS: Using different case criteria in different settings resulted in case groups that had a mix of similarities and differences. The clinical WEA cases were more likely to have visited a doctor’s office ≥3 times for asthma in the past year (75% versus 11%; P<0.0001), but did not seek more asthma-related emergency or in-patient care, or have lower spirometry values. The two groups differed substantially according to the industries and occupations where the cases worked.CONCLUSIONS: Findings from both types of studies should be considered when measuring the contribution of work to asthma exacerbations, identifying putative agents, and selecting industries and occupations in which to implement screening and surveillance programs.

scholarly journals Ergonomic Evaluation of Current Advancements in Blueberry Harvesting

Agronomy ◽  
2018 ◽  
Vol 8 (11) ◽  
pp. 266 ◽  
Author(s):  
Eunsik Kim ◽  
Andris Freivalds ◽  
Fumiomi Takeda ◽  
Changying Li
Keyword(s):  
Occupational Safety ◽  
Health And Safety ◽  
Field Studies ◽  
The United States ◽  
Epidemiological Studies ◽  
Component Ratio ◽  
Social Scientists ◽  
Private Industry ◽  
Work Related ◽  
Trauma Disorders

Work-related musculoskeletal disorders (MSDs) accounted for 32% of days-away-from-work cases in private industry in 2016. Several factors have been associated with MSDs, such as repetitive motion, excessive force, awkward and/or sustained postures, and prolonged sitting and standing, all of which are required in farm workers’ labor. While numerous epidemiological studies on the prevention of MSDs in agriculture have been conducted, an ergonomics evaluation of blueberry harvesting has not yet been systematically performed. The purpose of this study was to investigate the risk factors of MSDs for several types of blueberry harvesting (hand harvesting, semi-mechanical harvesting with hand-held shakers, and over-the-row machines) in terms of workers’ postural loads and self-reported discomfort using ergonomics intervention techniques. Five field studies in the western region of the United States between 2017 and 2018 were conducted using the Borg CR10 scale, electromyography (EMG), Rapid Upper Limb Assessment (RULA), the Cumulative Trauma Disorders (CTD) index, and the NIOSH (National Institute for Occupational Safety and Health) lifting equation. In evaluating the workloads of picking and moving blueberries by hand, semi-mechanical harvesting with hand-held shakers, and completely mechanized harvesting, only EMG and the NIOSH lifting equation were used, as labor for this system is limited to loading empty lugs and unloading full lugs. Based on the results, we conclude that working on the fully mechanized harvester would be the best approach to minimizing worker loading and fatigue. This is because the total component ratio of postures in hand harvesting with a RULA score equal to or greater than 5 was 69%, indicating that more than half of the postures were high risk for shoulder pain. For the semi-mechanical harvesting, the biggest problem with the shakers is the vibration, which can cause fatigue and various risks to workers, especially in the upper limbs. However, it would be challenging for small- and medium-sized blueberry farms to purchase automated harvesters due to their high cost. Thus, collaborative efforts among health and safety professionals, engineers, social scientists, and ergonomists are needed to provide effective ergonomic interventions.

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